BON SECOURS MERCY HEALTH PETERSBURG LLC (NPI# 1720623853) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720623853 |
| Entity Type | Organization |
| Organization Name | BON SECOURS MERCY HEALTH PETERSBURG LLC |
| Other Organization Name | SOUTHSIDE REGIONAL MEDICAL CENTER |
| Practice Address |
200 Medical Park Blvd Petersburg VA 23805-9274 |
| Mailing Address |
Po Box 639859 Cincinnati OH 45263-9859 |
| Practice Telephone | 8047655000 |
| Enumeration Date | 2019-11-13 |
| Last Update Date | 2020-11-06 |
| Authorized Official Name | KIMBERLY M RALSTON (DIRECTOR REIMBURSEMENT) |
| Authorized Official Telephone | 4199965119 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282N00000X | General Acute Care Hospital | Hospitals |
| Other Name | Type Code |
|---|---|
| SOUTHSIDE REGIONAL MEDICAL CENTER | Doing Business As Name - Organization |
| Street Address |
200 MEDICAL PARK BLVD |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23805-9274 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902413636 | Delesa Shana Kay Walden | Registered Nurse | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-09-27 |
| 1992339436 | Amy Kathryn Lansing | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-02-24 |
| 1588296453 | Erin Elise Layne | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-02-10 |
| 1295374643 | Crystal Leigh Maddox | Physical Therapist | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-01-02 |
| 1366081911 | Joshua Paul Pidcoe | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-12-31 |
| 1144874686 | Nina Thi Ong-pham | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-08-01 |
| 1720543507 | Martina Rochelle Washington | Specialist/Technologist, Other | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-02-05 |
| 1356812242 | Ams Virginia Pllc | Nurse Anesthetist, Certified Registered | 200 Medical Park Blvd, Petersburg, VA 23805 | 2018-12-17 |
| 1841761079 | Erin Collins | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2018-12-16 |
| 1265900260 | Casey Brennan | Nurse Practitioner | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2018-11-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134690647 | Miles Viant | Occupational Therapist | 287 E Blvd, Petersburg, VA 23805 | 2018-12-10 |
| 1245756964 | Dexter Shabazz Lett | Registered Nurse | 10543 S. Crater Rd, S. Prince George, VA 23805 | 2017-08-15 |
| 1891145876 | Taylor Enhanced Living | Counselor | 105 Holly Hill Dive, Suite A, Petersburg, VA 23805 | 2016-06-21 |
| 1700255205 | Ina Thompson | Counselor | 272 Medical Park Boulevard, Petersburg, VA 23805 | 2015-09-15 |
| 1932582541 | Valeria Edda Madrid Malo Bohorquez | Internal Medicine | 50 Medical Park Blvd Ste C, Petersburg, VA 23805 | 2015-06-30 |
| 1548642788 | Justin Andrew Phillingane | Podiatrist | 3335 S Crater Rd Ste 500, Petersburg, VA 23805 | 2015-06-24 |
| 1225417082 | Paladin Dermatology LLC | Nurse Practitioner | 44 A& B Medical Park Blvd, Petersburg, VA 23805 | 2015-05-27 |
| 1245652544 | Family Services Inc. | Health Maintenance Organization | 1045 Gustavo Lane, Petersburg, VA 23805 | 2014-01-06 |
| 1619268075 | Charlene Belangia | Massage Therapist | 3323 S. Crater Rd, Suite B, Petersburg, VA 23805 | 2011-04-20 |
| 1760709638 | Caresouth Hha Holdings of Virginia, LLC | Home Health | 34 Medical Park Boulevard, Suite G-h, Petersburg, VA 23805 | 2010-04-30 |
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| Taxonomy Code | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174630081 | Commonwealth of Va Hiram W Davis Medical Center | General Acute Care Hospital | 26317 W Washington St, Petersburg, VA 23803-0030 | 2006-08-24 |
| 1104899319 | Petersburg Hospital Company LLC | General Acute Care Hospital | 200 Medical Park Blvd, Petersburg, VA 23805 | 2006-02-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538669445 | Virginia Hospital Center Arlington Health System | General Acute Care Hospital | 8100 Boone Blvd Ste 140, Vienna, VA 22182-2665 | 2018-02-16 |
| 1871020651 | Virginia Internal Medicine Specialists LLC | General Acute Care Hospital | 44790 Maynard Sq Ste 320, Ashburn, VA 20147-6514 | 2017-05-11 |
| 1730615816 | Sentara Healthcare | General Acute Care Hospital | 100 Ireland St, Hampton, VA 23663-2150 | 2017-05-10 |
| 1528592573 | New York Presbyterian Hospital-weill Cornell | General Acute Care Hospital | 9644 Sutton Green Ct, Vienna, VA 22181-6105 | 2017-04-17 |
| 1386181733 | Lyle Purnell | General Acute Care Hospital | 100 Emancipation Dr Bldg 146, Hampton, VA 23667-0001 | 2017-01-24 |
| 1700233855 | Debra Hafer | General Acute Care Hospital | 33290 Chincoteague Rd, Wallops Island, VA 23337-2204 | 2016-05-18 |
| 1093161374 | Mawussi Komi | General Acute Care Hospital | 6271 Drew Dr, Va Beach, VA 23464 | 2016-05-05 |
| 1700248796 | Hq Surgical | General Acute Care Hospital | 905 Hathaway Ct, Chesapeake, VA 23322-7622 | 2016-03-28 |
| 1710355649 | Johnston Memorial Hospital, Inc | General Acute Care Hospital | 3175 Linden Dr Ste 3-5, Bristol, VA 24202-5849 | 2015-09-09 |
| 1184092298 | Anita Sites | General Acute Care Hospital | Uva Transplant Center 1300 Jefferson Park Ave Fl 4, Charlottesville, VA 22908-3363 | 2015-09-04 |
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| City | PETERSBURG |
| Zip Code | 23805 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.